MEDICARE: PATRICIA RICHARDSON LCDCIII

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	175235	OH
2	171M00000X	Case Manager/Care Coordinator
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	162165

General Provider Information

NPI Number	:	1497367890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA RICHARDSON LCDCIII

Provider Business Mailing Address
First Line	:	349 OLDE RIDENOUR RD
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-2528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	349 OLDE RIDENOUR RD
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-2528
Country	:	US
Telephone Number	:	614-300-3214
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	06/11/2025

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